Skip to main content
Top
Published in: Social Psychiatry and Psychiatric Epidemiology 4/2015

01-04-2015 | Original Paper

Community integration after deployment to Afghanistan: a longitudinal investigation of Danish soldiers

Authors: Karen-Inge Karstoft, Cherie Armour, Søren B. Andersen, Mette Bertelsen, Trine Madsen

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 4/2015

Login to get access

Abstract

Objective

In the years following military deployment, soldiers may experience problems integrating into the community. However, little is known about the nature and prevalence of these problems and if they relate to posttraumatic symptomatology.

Methods

In a prospective, longitudinal study of Danish soldiers deployed to Afghanistan in 2009 (N = 743), we assessed community reintegration difficulties 2.5 years after home coming (study sample: N = 454). Furthermore, symptoms of posttraumatic stress disorder (PTSD) were assessed before, during, and after deployment. Trajectories of PTSD symptoms from a previously published latent growth mixture modeling analysis were used to address whether community reintegration difficulties differ as a result of course and level of PTSD symptoms.

Results

Between 3.6 and 18.0 % reported to have some, a lot, or extreme difficulties in reintegration domains such as interpersonal functioning, productivity, community involvement, and self-care. Mean level of reintegration difficulties differed significantly across six PTSD symptom trajectories (range 6.35–36.00); with more symptomatic trajectories experiencing greater community reintegration difficulties.

Conclusions

Reintegration difficulties after deployment are present in less than 20 % of Danish soldiers who return from Afghanistan. Difficulties are greater in individuals who follow symptomatic PTSD trajectories in the first years following deployment than in those who follow a low-stable trajectory with no or few symptoms.
Appendix
Available only for authorised users
Literature
1.
go back to reference Gates MA, Holowka DW, Vasterling JJ, Keane TM, Marx BP et al (2012) Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition. Psychol Serv 9:361–382CrossRefPubMed Gates MA, Holowka DW, Vasterling JJ, Keane TM, Marx BP et al (2012) Posttraumatic stress disorder in veterans and military personnel: epidemiology, screening, and case recognition. Psychol Serv 9:361–382CrossRefPubMed
2.
go back to reference Sayer NA, Carlson KF, Frazier PA (2014) Reintegration challenges in U.S. service members and veterans following combat deployment. Soc Issues Policy Rev 8:33–73CrossRef Sayer NA, Carlson KF, Frazier PA (2014) Reintegration challenges in U.S. service members and veterans following combat deployment. Soc Issues Policy Rev 8:33–73CrossRef
3.
go back to reference Smith MW, Schnurr PP, Rosenheck RA (2005) Employment outcomes and PTSD symptom severity. Mental Health Services Res 7:89–101CrossRef Smith MW, Schnurr PP, Rosenheck RA (2005) Employment outcomes and PTSD symptom severity. Mental Health Services Res 7:89–101CrossRef
4.
go back to reference Zatzick DF, Marmar CR, Weiss DS, Browner WS, Metzler TJ et al (1997) Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry 154:1690–1695CrossRefPubMed Zatzick DF, Marmar CR, Weiss DS, Browner WS, Metzler TJ et al (1997) Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry 154:1690–1695CrossRefPubMed
5.
go back to reference Savoca E, Rosenheck R (2000) The civilian labor market experiences of Vietnam-era veterans: the influence of psychiatric disorders. J Mental Health Policy Econ 3:199–207CrossRef Savoca E, Rosenheck R (2000) The civilian labor market experiences of Vietnam-era veterans: the influence of psychiatric disorders. J Mental Health Policy Econ 3:199–207CrossRef
6.
go back to reference Iversen A, Nikolaou V, Greenberg N, Unwin C, Hull L et al (2005) What happens to British veterans when they leave the armed forces? Eur J Public Health 15:175–184CrossRefPubMed Iversen A, Nikolaou V, Greenberg N, Unwin C, Hull L et al (2005) What happens to British veterans when they leave the armed forces? Eur J Public Health 15:175–184CrossRefPubMed
7.
go back to reference Horton JL, Jacobson IG, Wong CA, Wells TS, Boyko EJ et al (2013) The impact of prior deployment experience on civilian employment after military service. Occup Environ Med 70:408–417CrossRefPubMed Horton JL, Jacobson IG, Wong CA, Wells TS, Boyko EJ et al (2013) The impact of prior deployment experience on civilian employment after military service. Occup Environ Med 70:408–417CrossRefPubMed
8.
go back to reference Schnurr PP, Lunney CA, Bovin MJ, Marx BP (2009) Posttraumatic stress disorder and quality of life: extension of findings to veterans of the wars in Iraq and Afghanistan. Clin Psychol Rev 29:727–735CrossRefPubMed Schnurr PP, Lunney CA, Bovin MJ, Marx BP (2009) Posttraumatic stress disorder and quality of life: extension of findings to veterans of the wars in Iraq and Afghanistan. Clin Psychol Rev 29:727–735CrossRefPubMed
9.
go back to reference Shea MT, Vujanovic AA, Mansfield AK, Sevin E, Liu FJ (2010) Posttraumatic stress disorder symptoms and functional impairment among OEF and OIF national guard and reserve veterans. J Trauma Stress 23:100–107PubMed Shea MT, Vujanovic AA, Mansfield AK, Sevin E, Liu FJ (2010) Posttraumatic stress disorder symptoms and functional impairment among OEF and OIF national guard and reserve veterans. J Trauma Stress 23:100–107PubMed
10.
go back to reference Elbogen EB, Johnson SC, Wagner HR, Newton VM, Beckham JC (2012) Financial well-being and postdeployment adjustment among Iraq and Afghanistan war veterans. Mil Med 177:669–675CrossRefPubMedCentralPubMed Elbogen EB, Johnson SC, Wagner HR, Newton VM, Beckham JC (2012) Financial well-being and postdeployment adjustment among Iraq and Afghanistan war veterans. Mil Med 177:669–675CrossRefPubMedCentralPubMed
11.
go back to reference Riggs DS, Byrne CA, Weathers FW, Litz BT (1998) The quality of the intimate relationships of male Vietnam veterans: problems associated with posttraumatic stress disorder. J Trauma Stress 11:87–101CrossRefPubMed Riggs DS, Byrne CA, Weathers FW, Litz BT (1998) The quality of the intimate relationships of male Vietnam veterans: problems associated with posttraumatic stress disorder. J Trauma Stress 11:87–101CrossRefPubMed
12.
go back to reference Allen ES, Rhoades GK, Stanley SM, Markman HJ (2010) Hitting home: relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for army couples. J Fam Psychol 24:280–288CrossRefPubMedCentralPubMed Allen ES, Rhoades GK, Stanley SM, Markman HJ (2010) Hitting home: relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for army couples. J Fam Psychol 24:280–288CrossRefPubMedCentralPubMed
13.
go back to reference Sayer NA, Frazier P, Orazem RJ, Murdoch M, Gravely A et al (2011) Military to civilian questionnaire: a measure of postdeployment community reintegration difficulty among veterans using Department of Veterans Affairs medical care. J Trauma Stress 24:660–670CrossRefPubMed Sayer NA, Frazier P, Orazem RJ, Murdoch M, Gravely A et al (2011) Military to civilian questionnaire: a measure of postdeployment community reintegration difficulty among veterans using Department of Veterans Affairs medical care. J Trauma Stress 24:660–670CrossRefPubMed
14.
go back to reference Sayer NA, Noorbaloochi S, Frazier P, Carlson K, Gravely A et al (2010) Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatr Services 61:589–597CrossRef Sayer NA, Noorbaloochi S, Frazier P, Carlson K, Gravely A et al (2010) Reintegration problems and treatment interests among Iraq and Afghanistan combat veterans receiving VA medical care. Psychiatr Services 61:589–597CrossRef
15.
go back to reference Beder J, Coe R, Sommer D (2011) Women and men who have served in Afghanistan/Iraq: coming home. Soc Work Health Care 50:515–526CrossRefPubMed Beder J, Coe R, Sommer D (2011) Women and men who have served in Afghanistan/Iraq: coming home. Soc Work Health Care 50:515–526CrossRefPubMed
16.
go back to reference Dickstein BD, Suvak M, Litz BT, Adler AB (2010) Heterogeneity in the course of posttraumatic stress disorder: trajectories of symptomatology. J Trauma Stress 23:331–339PubMed Dickstein BD, Suvak M, Litz BT, Adler AB (2010) Heterogeneity in the course of posttraumatic stress disorder: trajectories of symptomatology. J Trauma Stress 23:331–339PubMed
17.
go back to reference Berntsen D, Johannessen KB, Thomsen YD, Bertelsen M, Hoyle RH et al (2012) Peace and war: trajectories of posttraumatic stress disorder symptoms before, during, and after military deployment in Afghanistan. Psychol Sci 23:1557–1565CrossRefPubMedCentralPubMed Berntsen D, Johannessen KB, Thomsen YD, Bertelsen M, Hoyle RH et al (2012) Peace and war: trajectories of posttraumatic stress disorder symptoms before, during, and after military deployment in Afghanistan. Psychol Sci 23:1557–1565CrossRefPubMedCentralPubMed
18.
go back to reference Bonanno GA, Mancini AD, Horton JL, Powell TM, LeardMann CA et al (2012) Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study. Br J Psychiatry 200:317–323CrossRefPubMed Bonanno GA, Mancini AD, Horton JL, Powell TM, LeardMann CA et al (2012) Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study. Br J Psychiatry 200:317–323CrossRefPubMed
19.
go back to reference Orcutt HK, Erickson DJ, Wolfe J (2004) The course of PTSD symptoms among Gulf War Veterans: a growth mixture modeling approach. J Trauma Stress 17:195–202CrossRefPubMed Orcutt HK, Erickson DJ, Wolfe J (2004) The course of PTSD symptoms among Gulf War Veterans: a growth mixture modeling approach. J Trauma Stress 17:195–202CrossRefPubMed
20.
go back to reference Weathers FW, Litz BT, Herman D, Huska J, Keane TM (1993) The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. The annual convention of the International Society for Traumatic Stress Studies, San Antonio Weathers FW, Litz BT, Herman D, Huska J, Keane TM (1993) The PTSD Checklist (PCL): reliability, validity, and diagnostic utility. The annual convention of the International Society for Traumatic Stress Studies, San Antonio
21.
go back to reference Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA (1996) Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 34:669–673CrossRefPubMed Blanchard EB, Jones-Alexander J, Buckley TC, Forneris CA (1996) Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 34:669–673CrossRefPubMed
22.
go back to reference Muthen LK, Muthen BO (1998–2012) Mplus User’s Guide, Los Angeles Muthen LK, Muthen BO (1998–2012) Mplus User’s Guide, Los Angeles
23.
go back to reference Andersen SB, Karstoft KI, Bertelsen MB, Madsen T (2014) Latent trajectories of trauma symptoms and resilience: the 3-year longitudinal prospective USPER study of Danish veterans deployed in Afghanistan. J Clin Psychiatry 75(9):1001–1008CrossRefPubMed Andersen SB, Karstoft KI, Bertelsen MB, Madsen T (2014) Latent trajectories of trauma symptoms and resilience: the 3-year longitudinal prospective USPER study of Danish veterans deployed in Afghanistan. J Clin Psychiatry 75(9):1001–1008CrossRefPubMed
24.
go back to reference Asparouhov T (2007) Wald test of mean equality for potential latent class predictors in mixture modeling. Technical Appendix Asparouhov T (2007) Wald test of mean equality for potential latent class predictors in mixture modeling. Technical Appendix
25.
go back to reference Clark SL, Muthen BO (2009) Relating latent class analysis results to variables not included in the analysis Clark SL, Muthen BO (2009) Relating latent class analysis results to variables not included in the analysis
26.
go back to reference Karstoft KI, Andersen SB, Bertelsen M, Madsen T (2013) Diagnostic accuracy of the posttraumatic stress disorder checklist—civilian version in a representative military sample. Psychol Assess 26:321–325CrossRefPubMed Karstoft KI, Andersen SB, Bertelsen M, Madsen T (2013) Diagnostic accuracy of the posttraumatic stress disorder checklist—civilian version in a representative military sample. Psychol Assess 26:321–325CrossRefPubMed
Metadata
Title
Community integration after deployment to Afghanistan: a longitudinal investigation of Danish soldiers
Authors
Karen-Inge Karstoft
Cherie Armour
Søren B. Andersen
Mette Bertelsen
Trine Madsen
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 4/2015
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-014-0973-2

Other articles of this Issue 4/2015

Social Psychiatry and Psychiatric Epidemiology 4/2015 Go to the issue

Letter to the Editor

Letter to the Editor